Disinfection of Needleless Catheter Connectors and Access Ports With Alcohol May Not Prevent Microbial Entry: The Promise of a Novel Antiseptic-Barrier Cap

2006 ◽  
Vol 27 (1) ◽  
pp. 23-27 ◽  
Author(s):  
Steve Z. Menyhay ◽  
Dennis G. Maki
Keyword(s):  
Significant Risk ◽  
Bloodstream Infections ◽  
The United States ◽  
Injection Port ◽  
Bloodborne Pathogens ◽  
Continuous Contact ◽  
Colony Forming Units ◽  
To Come ◽  
High Level ◽  
Membranous Septum

Background.Needleless valve connectors for vascular catheters are widely used throughout the United States because they reduce the risk of biohazardous injuries from needlesticks and exposure to bloodborne pathogens, such as human immunodeficiency virus and hepatitis C virus. Patients with long-term central venous catheters are at significant risk of acquiring catheter-related bloodstream infections caused by microbes that gain access through the connection between the administration set and the catheter or an injection port. Most healthcare practitioners wipe the membranous septum of the needleless connector or the injection port with 70% alcohol before accessing it. We report a simulation study of the efficacy of conventional alcohol disinfection before access, compared with that of a novel antiseptic-barrier cap that, when threaded onto a needleless luer-activated valved connector, allows a chlorhexidine-impregnated sponge to come into continuous contact with the membranous surface; after removal of the cap, there is no need to disinfect the surface with alcohol before accessing it.Methods.One hundred five commercial, needleless luer-activated valved connectors, each accessible by a blunt male-connector luer-lock attachment, were purchased from 3 manufacturers and were tested. The membranous septum of each test device was first heavily contaminated with ~105colony-forming units ofEnterococcus faecalisand then was allowed to dry for 24 hours. Fifteen of the contaminated devices were not disinfected (positive controls), 30 were conventionally disinfected with a commercial 70% alcohol pledget, and 60 had the antiseptic cap threaded onto the connector and then removed after 10 minutes. The test connectors were then accessed with a sterile syringe containing nutrient broth media, which was injected, captured on the downstream side of the intraluminal fluid pathway, and cultured quantitatively.Results.All 15 control connectors (100%) showed massive transmission of microorganisms across the membranous septum (4,500-10,000 colony-forming units). Of the 30 connectors accessed after conventional disinfection with 70% alcohol, 20 (67%) showed transmission of microorganisms (442-25,000 colony-forming units). In contrast, of the 60 connectors cultured after application of the novel antiseptic cap, only 1 (1.6%) showed any transmission of microorganisms (P<.001).Conclusions.The findings of this study show that, if the membranous septum of a needleless luer-activated connector is heavily contaminated, conventional disinfection with 70% alcohol does not reliably prevent entry of microorganisms. In contrast, the antiseptic-barrier cap provided a high level of protection, even in the presence of very heavy contamination. This novel technology deserves to be studied in a clinical trial.

The Role of Organized Labor in Combating the Hepatitis B and Aids Epidemics: The Fight for an Osha Bloodborne Pathogens Standard

1995 ◽  
Vol 25 (1) ◽  
pp. 129-152 ◽  
Author(s):  
William A. Muraskin
Keyword(s):  
United States ◽  
At Risk ◽  
Hepatitis B ◽  
Health Care Professionals ◽  
Significant Risk ◽  
The United States ◽  
Hepatitis B Vaccination ◽  
Health Administration ◽  
Public Attention ◽  
Bloodborne Pathogens

The United States is experiencing a hepatitis B epidemic that has until recently received relatively little public attention. Many groups of workers are at risk of infection, death, or chronic carriership because of workplace exposure to blood; those at risk include not only health care professionals but police, fire fighters, life guards, hospital-based laundry and cafeteria workers, park rangers, sanitation workers, etc. One of the most important victories against the hepatitis B pandemic in the United States occurred when the Occupational Safety and Health Administration issued a Bloodborne Pathogens Standard that required employers to protect 5½ million workers from infection by offering those at risk free hepatitis B vaccination, and forced employers to bear the costs of providing equipment (e.g., gloves, gowns, masks, puncture-proof containers) to maintain “universal precautions” for employees handling bodily fluids. While most people assume the new standard was primarily aimed at fighting the AIDS epidemic, it was actually based on the more significant risk posed by hepatitis B infection. The standard resulted not from leadership provided by the experts in the Public Health Service mandated to control infectious disease, but rather from pressure applied by labor unions—providing a clear example of the continued importance of unions for worker protection in our supposedly post-union era.

Looking Out for Something Better to Come: Interview with Director Hanna Polak

2016 ◽  
Vol 69 (4) ◽  
pp. 65-71
Author(s):  
Masha Shpolberg
Keyword(s):  
United States ◽  
The United States ◽  
Hair Color ◽  
Yale University ◽  
Garbage Dump ◽  
To Come

Hanna Polak was in the United States in December 2015 for a screening of Something Better to Come (2014) and The Children of Leningradsky (2004) at Yale University, where the interview was conducted. Polak's devastating documentary Something Better to Come swept through the festival circuit with force, winning a Special Jury Award at IDFA along with awards at over twenty other festivals. Shot illegally on a garbage dump just outside Moscow over the course of fourteen years, the film follows a girl named Yula from age 10 to 24, as she grows up doing the things that teenagers everywhere do—experimenting with her hair color and makeup, with cigarettes and alcohol—all while living in the most difficult of conditions.

The Racial and Economic Context of Trump Support: Evidence for Threat, Identity, and Contact Effects in the 2016 Presidential Election

2018 ◽  
Author(s):  
Eric Knowles ◽  
Linda Tropp
Keyword(s):  
The United States ◽  
Local Economy ◽  
Racial Identification ◽  
White Americans ◽  
Social Scientists ◽  
Neighborhood Diversity ◽  
Nationally Representative ◽  
To Come ◽  
Neighborhood Level ◽  
Support Evidence

Donald Trump's ascent to the Presidency of the United States defied the expectations of many social scientists, pundits, and laypeople. To date, most efforts to understand Trump's rise have focused on personality and demographic characteristics of White Americans. In contrast, the present work leverages a nationally representative sample of Whites to examine how contextual factors may have shaped support for Trump during the 2016 presidential primaries. Results reveal that neighborhood-level exposure to racial and ethnic minorities is associated with greater group threat and racial identification among Whites, as well as greater intentions to vote for Trump in the general election. At the same time, however, neighborhood diversity afforded Whites with opportunities for intergroup contact, which is associated with lower levels of threat, White identification, and Trump support. Further analyses suggest that a healthy local economy mutes threat effects in diverse contexts, allowing contact processes to come to the fore.

Migration for Mission

2019 ◽  
Author(s):  
Mary Johnson ◽  
Patricia Wittberg ◽  
Mary Gautier ◽  
Thu Do
Keyword(s):  
United States ◽  
Qualitative Data ◽  
The United States ◽  
National Study ◽  
Catholic Sisters ◽  
Long Line ◽  
Catholic Organizations ◽  
To Come ◽  
Washington University ◽  
The Trinity

This book presents quantitative and qualitative data from the first-ever national study of international Catholic sisters in the United States, the Trinity Washington University/CARA Study. International sisters are defined as those born outside the United States and currently ministering, studying, or in residence in this country. The book begins with a chapter that locates current international sisters in the long line of sisters who have come to this country since the eighteenth century. The book identifies the sisters of today, describes the pathways they used to come here, their levels of satisfaction, their concerns and contributions, the issue of immigration status, the challenges of sister students, and the role and mission of Catholic organizations assisting immigrants in general, and international sisters in particular. The book ends with implications of the research and recommendations regarding resources, ministries, and structures of support for international sisters.

Climate Justice

2018 ◽  
Keyword(s):  
Climate Change ◽  
Sustainable Development Goals ◽  
Climate Justice ◽  
Policy Discourse ◽  
Mary Robinson ◽  
The Public ◽  
Development Goals ◽  
To Come ◽  
Run Up ◽  
High Level

Climate justice requires sharing the burdens and benefits of climate change and its resolution equitably and fairly. It brings together justice between generations and justice within generations. The United Nations Sustainable Development Goals summit in September 2015, and the Conference of Parties to the Framework Convention on Climate Change in Paris in December 2015, brought climate justice center stage in global discussions. In the run up to Paris, Mary Robinson, former president of Ireland and the UN Secretary General’s Special Envoy for Climate Change, instituted the Climate Justice Dialogue. The editors of this volume, an economist and a philosopher, served on the High Level Advisory Committee of the Climate Justice Dialogue. They noted the overlap and mutual enforcement between the economic and philosophical discourses on climate justice. But they also noted the great need for these strands to come together to support the public and policy discourse. This volume is the result.

Student Privacy and the Law in the Internet Age

2019 ◽  
Author(s):  
Leah Plunkett ◽  
Urs Gasser ◽  
Sandra Cortesi
Keyword(s):  
Learning Environments ◽  
School Environment ◽  
Privacy Protection ◽  
Data Privacy ◽  
Digital Technologies ◽  
The United States ◽  
Legal Framework ◽  
Privacy Law ◽  
Student Privacy ◽  
High Level

New types of digital technologies and new ways of using them are heavily impacting young people’s learning environments and creating intense pressure points on the “pre-digital” framework of student privacy. This chapter offers a high-level mapping of the federal legal landscape in the United States created by the “big three” federal privacy statutes—the Family Educational Rights and Privacy Act (FERPA), the Children’s Online Privacy Protection Act (COPPA), and the Protection of Pupil Rights Amendment (PPRA)—in the context of student privacy and the ongoing digital transformation of formal learning environments (“schools”). Fissures are emerging around key student privacy issues such as: what are the key data privacy risk factors as digital technologies are adopted in learning environments; which decision makers are best positioned to determine whether, when, why, and with whom students’ data should be shared outside the school environment; what types of data may be unregulated by privacy law and what additional safeguards might be required; and what role privacy law and ethics serve as we seek to bolster related values, such as equity, agency, and autonomy, to support youth and their pathways. These and similar intersections at which the current federal legal framework is ambiguous or inadequate pose challenges for key stakeholders. This chapter proposes that a “blended” governance approach, which draws from technology-based, market-based, and human-centered privacy protection and empowerment mechanisms and seeks to bolster legal safeguards that need to be strengthen in parallel, offers an essential toolkit to find creative, nimble, and effective multistakeholder solutions.

Crystallex Int'l Corp. v. Bolivarian Rep. Venez. (3D Cir.)

2021 ◽  
pp. 1-21
Author(s):  
Kevin D. Benish
Keyword(s):  
United States Supreme Court ◽  
The United States ◽  
United States Supreme ◽  
Decision To Leave ◽  
Court Of Appeals ◽  
The Third ◽  
To Come ◽  
Alter Ego ◽  
Oil Company ◽  
The U.S

On May 18, 2020, the United States Supreme Court denied a request by the Bolivarian Republic of Venezuela and its state-owned oil company, Petróleos de Venezuela, S.A. (PDVSA), to review the merits of Crystallex Int'l Corp. v. Bolivarian Republic of Venezuela, a decision by the U.S. Court of Appeals for the Third Circuit. In Crystallex, the Third Circuit affirmed a trial court's determination that PDVSA is the “alter ego” of Venezuela itself, thus permitting Crystallex to enforce a $1.4 billion judgment against Venezuela by attaching property held in PDVSA's name. Given the Supreme Court's decision to leave the Third Circuit's opinion undisturbed, Crystallex is a significant decision that may affect parties involved in transnational litigation for years to come—especially those pursuing or defending against U.S. enforcement proceedings involving the property of foreign states.

scholarly journals THU0442 GOUT AND HEART FAILURE IN THE US: A NATIONAL PERSPECTIVE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 458.2-458
Author(s):  
G. Singh ◽  
M. Sehgal ◽  
A. Mithal
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Confidence Intervals ◽  
Burden Of Illness ◽  
Average Length ◽  
Private Insurance ◽  
Significant Risk ◽  
Case Fatality ◽  
The United States ◽  
The Us

Background:Heart failure (HF) is the eighth leading cause of death in the US, with a 38% increase in the number of deaths due to HF from 2011 to 2017 (1). Gout and hyperuricemia have previously been recognized as significant risk factors for heart failure (2), but there is little nationwide data on the clinical and economic consequences of these comorbidities.Objectives:To study heart failure hospitalizations in patients with gout in the United States (US) and estimate their clinical and economic impact.Methods:The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. We examined all inpatient hospitalizations in the NIS in 2017, the most recent year of available data, with a primary or secondary diagnosis of gout and heart failure. Over 69,800 ICD 10 diagnoses were collapsed into a smaller number of clinically meaningful categories, consistent with the CDC Clinical Classification Software.Results:There were 35.8 million all-cause hospitalizations in patients in the US in 2017. Of these, 351,735 hospitalizations occurred for acute and/or chronic heart failure in patients with gout. These patients had a mean age of 73.3 years (95% confidence intervals 73.1 – 73.5 years) and were more likely to be male (63.4%). The average length of hospitalization was 6.1 days (95% confidence intervals 6.0 to 6.2 days) with a case fatality rate of 3.5% (95% confidence intervals 3.4% – 3.7%). The average cost of each hospitalization was $63,992 (95% confidence intervals $61,908 - $66,075), with a total annual national cost estimate of $22.8 billion (95% confidence intervals $21.7 billion - $24.0 billion).Conclusion:While gout and hyperuricemia have long been recognized as potential risk factors for heart failure, the aging of the US population is projected to significantly increase the burden of illness and costs of care of these comorbidities (1). This calls for an increased awareness and management of serious co-morbid conditions in patients with gout.References:[1]Sidney, S., Go, A. S., Jaffe, M. G., Solomon, M. D., Ambrosy, A. P., & Rana, J. S. (2019). Association Between Aging of the US Population and Heart Disease Mortality From 2011 to 2017. JAMA Cardiology. doi:10.1001/jamacardio.2019.4187[2]Krishnan E. Gout and the risk for incident heart failure and systolic dysfunction. BMJ Open 2012;2:e000282.doi:10.1136/bmjopen-2011-000282Disclosure of Interests: :Gurkirpal Singh Grant/research support from: Horizon Therapeutics, Maanek Sehgal: None declared, Alka Mithal: None declared

scholarly journals Beyond Religiosity: A Model to Explain Spirituality Among Middle-Aged and Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 413-414
Author(s):  
Carlyn Vogel ◽  
Debra Dobbs ◽  
Brent Small
Keyword(s):  
United States ◽  
Older Adults ◽  
Good Life ◽  
Multinomial Logistic Regression ◽  
College Experience ◽  
The United States ◽  
Strong Connection ◽  
Deep Appreciation ◽  
The World ◽  
High Level

Abstract Spirituality is difficult to define as researchers assign it different meanings and individuals’ perceptions can vary. For example, spirituality may connect to religiosity, while others consider religiosity a less significant part of spirituality. This study investigates factors outside of religiosity that are significantly associated with spirituality to inform the characteristics of the concept. Webster’s (2004) existential framework of spirituality was used to guide variable selection. The National Survey of Midlife in the United States wave three (MIDUS 3; 2013-2014; n = 2,594; Mage = 63.5, SD = 11, range = 39–92) was used to examine individuals’ reported levels of spirituality. Multinomial logistic regression was conducted to examine factors related to low and high levels of spirituality compared to a moderate level. Participants with low spirituality were more likely to be male, less likely to be mindful, mediate/chant, feel a strong connection to all life, to indicate that they cannot make sense of the world, and to be religious. Participants with high spirituality were more likely to be female, have at least some college experience, be mindful, meditate/chant, feel deep inner peace, have a sense of deep appreciation, think that a sense of purpose is important for a good life, and have a high level of religiosity. Framed by Webster’s conceptual model, the current study observed that religiosity is significantly associated with spirituality and that other mindfulness-based aspects are also present within this concept. Incorporating mindfulness with religious efforts will more accurately and holistically address spirituality.

scholarly journals Belonging in the Coronaverse: Will There Be Time?

2021 ◽  
Vol 1 (1) ◽  
pp. 100-115
Author(s):  
Kate Fischer ◽  
Malika Rakhmonova ◽  
Mike Tran
Keyword(s):  
College Experience ◽  
The United States ◽  
Limited Time ◽  
The Novel ◽  
Residential University ◽  
To Come ◽  
Novel Coronavirus ◽  
University Experience ◽  
The U.S ◽  
Older Siblings

Abstract Since the spring of 2020 SARS-CoV-2, the novel coronavirus, has upended lives and caused a rethinking of nearly all social behaviors in the United States. This paper examines the ways in which the pandemic, shutdown, and gradual move towards “normal” have laid bare and obfuscated societal pressures regarding running out of time as it pertains to the residential university experience. Promised by movies, television, and older siblings and friends as a limited-time offer, the “typical” college experience is baked into the U.S. imaginary, reinforcing a host of notions of who “belongs” on campus along lines of race, class, and age. Fed a vision of what their whole lives “should be”, students who enter a residential four-year college are already imbued with a nostalgia for what is yet to come, hailed, in Althusser’s (2006[1977]) sense, as university subjects even before their first class. The upheaval of that subjecthood during the pandemic has raised important questions about the purpose of the college experience as well as how to belong to a place that is no longer there.

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